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Where's the os?From: Braun, R. Daniel (rbraun@iupui.edu)Fri Mar 10 08:52:08 2000
A 38 y/o patient had a conization in 1982. About 7 days later, she developed post cone bleeding and had another operation. Do not know either the Pathology or the nature of the second operation. In 1990, she had a Pap smear reported as HGSIL. Because of her previous experience with conization, she refused colposcopy because it could lead to conization. Since then, she has had 6 Pap smears, All revealed NPC and all but 1 were reported as Inadequate due to lack of endocervical or metaplastic cells. The one exception makes no comment at all about adequacy. On speculum exam, there are many infoldings in the vagina at the apex and nothing that looks like a cervical os. (She has monthly periods, fairly regular and assoc. with moderate cramping) On bimaual exam there is what feels like a normal cervix and a normal uterine exam. TVS reveals normal uterus and ovaries. Repeat Pap by me reported as inadequate, no endocervical or metaplastic cells noted. I had her come in during a menses. She has blood in the vagina. I am unable to find the opening through which it is coming. No real tract visualized. Suggestions??? Conization is unacceptable to the patient. Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN 46202 OBGYN.net International Representative for United States Certified AllExperts Expert Check out my bio/ratings page! http://www.allexperts.com/displayExpert.asp?Expert=1236
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